Individual provider Active NPI

Shelby Rae Clark, APRN

  • Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1669225827
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1156851 Issued in TX
Practice address
520 E Euclid Ave
San Antonio, TX 78212-4414
Phone
(210) 581-2837
Fax
(210) 853-2718
NPI assigned
Apr 8, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 1156851 TX
Nurse Practitioner 363L00000X 1156851 TX Primary

Addresses

Primary practice location

520 E Euclid Ave
San Antonio, TX 78212-4414

Mailing address

12047 FM 1957 Ste 104
San Antonio, TX 78253-9244

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024002590 TX Practitioner - Nurse Practitioner 6800329186 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

520 E Euclid Ave
San Antonio, TX 78212-4414
Phone (210) 271-0606

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1156851TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Digestive Disease Consultants, PLLC CurrentSince Sep 30, 2024 Accepting new patients
Texas Digestive Disease Consultants PLLC CurrentSince Sep 30, 2024 Accepting new patients
Texas Digestive Disease Consultants, PLLC Current Accepting new patients

Locations

18220 Tomball Pkwy
Ste 290
Houston, TX 77070
Phone (281) 807-6800

601 S Main St
Keller, TX 76248
Phone (817) 741-4347

5425 W Spring Creek Pkwy
Ste 205
Plano, TX 75024
Phone (972) 526-5860

520 E Euclid Ave
San Antonio, TX 78212

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1669225827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12047 FM 1957 STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782539244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E EUCLID AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124414",
            "telephone_number": "210-581-2837",
            "fax_number": "210-853-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHELBY",
        "middle_name": "RAE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1156851",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1156851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.